Elderly Benign Prostatic Hyperplasia Research Articles

Expression and Significance of D-Dimer and Fibrinogen in Hyperfibrinolysis of Elderly Patients with Bleeding after BPH Operation.

Objective To explore the expression level and diagnostic efficacy of plasma D-dimer (DD) and fibrinogen (FIB) in hyperfibrinolysis of elderly patients with bleeding after benign prostatic hyperplasia (BPH) surgery. Methods 70 elderly BPH patients with postoperative hemorrhage and hyperfibrinolysis in our hospital were included into the observation group, and 75 elderly BPH patients with postoperative hemorrhage without hyperfibrinolysis were included into the control group. The serum levels of DD and FIB in the two groups of patients were compared, and the correlation of DD and FIB with clinical features and the diagnostic value of DD and FIB. Results Elderly BPH patients with hyperfibrinolysis showed significantly higher levels of DD and FIB than those without hyperfibrinolysis (P < 0.01). The increase in DD and the decrease of FIB were significantly correlated with the prolonged hospital stay and intensive care unit (ICU) monitoring (P < 0.05). The combination of DD and FIB showed high diagnostic value for postoperative hemorrhage with hyperfibrinolysis (AUC = 0.998). Conclusion The combination of plasma DD and FIB effectively and accurately diagnoses postoperative hemorrhage with hyperfibrinolysis. High levels of DD and FIB indicate prolonged hospital stay and postoperative ICU monitoring of elderly BPH patients with hyperfibrinolysis.

Tadalafil 5 mg Once Daily Improved Each IPSS Subscore, QOL, and Nocturia in Elderly BPH Patients over 70 Years Old in a Real-World Clinical Setting

Objective: No reports have evaluated the treatment effects of tadalafil by age group in a positive, noninterventional observational study of Japanese men. The present study aimed to evaluate the treatment effects of tadalafil by age group in a positive, noninterventional observational study of Japanese men. We therefore divided patients into 2 groups about the age of 70 years and investigated the treatment effects of tadalafil regarding voiding and storage functions by age group. Methods: Changes from baseline in each parameter (International Prostate Symptom Score [IPSS], quality of life [QOL] score, Overactive Bladder Symptom Score [OABSS], and residual urine volume) at 4, 12, and 24 weeks after initiating tadalafil for benign prostatic hyperplasia (BPH) patients were compared between groups (50–69 years vs. ≥70 years). In addition, side effects of tadalafil were investigated by age group. Results: In the 50–69 years group, significant improvements from baseline were seen in IPSS total and QOL score for all time points. In addition, significant improvements in IPSS storage subscore from baseline were observed at the 4- and 24-week time points. In the ≥70 years group, significant improvements from baseline were seen in IPSS total, IPSS voiding and storage subscores, and QOL score at each time point. Conclusions: Tadalafil 5 mg once daily appeared effective in clinical settings for elderly BPH patients even over 70 years old.

Dysuria self-management experience among home elderly patients with prostatic hyperplasia: a qualitative study

Objective To understand the dysuria self-management experience among home elderly patients with benign prostatic hyperplasia (BPH) so as to provide a basis for taking targeted nursing intervention. Methods From March to May 2018, we selected 14 home elderly patients with BPH living in community at the First Affiliated Hospital of Soochow University as subjects by purposive sampling. We collected data with semi-structured interview, the phenomenological method of qualitative study. Sort, analysis and refining theme was carried out to these data with the Colaizzi phenomenological approach. Results A total of four themes on dysuria self-management experience were refined among home elderly patients with BPH living in community including being with various besets (influencing sleep quality, inconvenient daily life and psychological distress) , lack of self-management knowledge and capability (vague recognition on disease, paying no attention to related symptoms, poor treatment compliance and insufficient action) , attitudes towards dysuria varying from person to person (indifferent, negative, seeking treatment positively) and expecting to get professional guidance as well as help. Conclusions Cognition and experience on disease of elderly BPH patients reflects insufficient knowledge. Nurses should pay attention to demands of home elderly BPH patients on dysuria self-management and strengthen disease management so as to improve self-management skills. Key words: Prostatic hyperplasia; Aged; Dysuria; Self-management; Qualitative research; Real experience

M2 macrophage-mediated interleukin-4 signalling induces myofibroblast phenotype during the progression of benign prostatic hyperplasia

Benign prostatic hyperplasia (BPH) is a progressive disease in elderly men, but potential factors accelerating its progression remain largely unknown. The aim of this study was to elucidate the factors affecting BPH progression by understanding the complex mechanisms causing early- progressed BPH, which progresses rapidly and requires surgical intervention before the age of 50. Three groups of human prostate tissue samples, from patients with early-progressed BPH, age-matched prostate and elderly BPH tissues, were collected (n = 25 each). We compared these tissues to determine the histologic features and molecular mechanisms underlying BPH progression. We found that early-progressed BPH samples were characterised by aberrant stromal hyper-proliferation, collagen deposition and increased M2 macrophage infiltration, compared to those from age-matched prostate and elderly BPH tissues. The M2 macrophage–fibroblast co-culture system demonstrated that the myofibroblast phenotypes were strongly induced only in fibroblasts from the early-progressed BPH samples, while the co-cultured M2 macrophages expressed high levels of pro-fibrotic cytokines, such as IL4 and TGFβ1. M2 macrophage-derived IL4, but not TGFβ1, selectively induced the myofibroblast phenotype through the JAK/STAT6, PI3K/AKT and MAPK/ERK signalling pathways in the early-progressed BPH prostate fibroblasts. Taken together, our results indicate that induction of the myofibroblast phenotype may lead to BPH progression through M2 macrophage-mediated IL4 signalling, and that IL4 may represent a potential therapeutic target, allowing the prevention of M2 macrophage activation and fibroblast-to-myofibroblast differentiation.

Cognitive functions and health-related quality of life in men with benign prostatic hyperplasia and symptoms of overactive bladder when treated with a combination of tamsulosin and solifenacin in a higher dosage

Aim: To study the cognitive functions and health-related quality of life (HRQoL) in individuals taking a combination of tamsulosin and solifenacin in a higher dosage.Methods: All patients (n = 262) were assigned to group A (N = 93, tamsulosin 0.4 mg + solifenacin 10 mg per day), group B (N = 83, tamsulosin 0.4 mg + solifenacin 20 mg), and control group C (N = 86; tamsulosin 0.4 mg + placebo). The lower urinary tract (LUT) condition was assessed on the scales International Prostate Symptom Score, Over Active Bladder Awareness Tool and uroflowmetry. The state of cognitive status was assessed on the scales Mini-mental State Examination, Controlled Oral Word Association Test, Wechsler Adult Intelligence Scale-Revised, Wechsler III, Color Trails Test, California Verbal Learning Test.Results: The values of cognitive function indicators in the individuals from all groups after treatment did not significantly differ from the respective values at the baseline (p > .05). The values of most HRQoL parameters of the functional state of the LUT significantly improved in groups A and B. A significant correlation between the state of cognitive status and HRQoL, as well as LUT was absent (r <0.3).Conclusion: The combination of solifenacin in a double dosage along with tamsulosin can be recommended for elderly benign prostatic hyperplasia patients with overactive bladder symptoms.

Impact of Metabolic Syndrome on Benign Prostatic Hyperplasia in Elderly Chinese Men

Objective: The aim of the present study was to evaluate the impact of metabolic syndrome (MetS) on benign prostatic hyperplasia (BPH) in elderly Chinese men. Methods: A total of 401 elderly BPH patients were divided into the without or with MetS group to assess the associations of MetS and components of MetS with BPH. Urologic evaluation included prostate volume, International Prostate Symptom Score, serum prostate-specific antigen, duration of concomitant lower urinary tract symptoms (LUTS) and maximum flow rate. Results: Body mass index (BMI), waist circumference, fasting glucose, glycosylated hemoglobin, triglyceride, fasting insulin (FINS), insulin resistance assessed by homeostasis model assessment (HOMA-IR) were greater and high-density lipoprotein cholesterol (HDL-C) was lower in BPH patients with MetS than in those without MetS. The patients with MetS showed a significantly larger prostate volume (p = 0.000) and longer duration of LUTS (p = 0.006) than those without MetS. Prostate volume was positively correlated with BMI (p = 0.000), FINS (p = 0.001), HOMA-IR (p = 0.003) and inversely correlated with HDL-C (p = 0.000). Multiple linear regression analysis showed that prostate volume was significantly correlated with HOMA-IR (p = 0.015). Conclusions: Our results suggest that MetS, BMI, low HDL-C level, increased serum insulin and especially insulin resistance are considered risk factors for prostate enlargement in elderly Chinese men.

Diagnostic and therapeutic status of benign prostatic hyperplasia outpatients at department of geriatrics in China

To assess the diagnostic and therapeutic modality preferences of physician implementation of the Chinese Clinical Practice Guidelines for Benign Prostatic Hyperplasia (BPH) for geriatric BPH patients. This cross-sectional survey was conducted at 33 medical centers located in 11 different cities in China (4 in north; 7 in south). A total of 190 physicians were requested to record their preferences in diagnostic tests and treatment options for elderly BPH cases. The physician response rate was 97.4%. Respondents generally selected those practices consistent with the guidelines, but their preferences for recommended tests varied. The use of medical history, ultrasonography and urinalysis was higher (> 90.0%) and that of uroflowmetry was lower (31.2%). In addition, the rate of use of recommended tests was higher among physicians in the north than those in the south. Drug therapy was the preferred treatment option. The proportion of drug treatment increased with the severity of symptoms in elder patients. In the south, the proportion of drug treatment in severe cases increased to 82.6% versus 61.9% in mild cases. In the north, the proportion of rug treatment in severe cases increased to 83.5% versus 54.6% in mild cases. This study provides insights into the physician preferences of diagnosis and treatment. The physicians generally comply with the BPH clinical practice guidelines. It may also serve as a practical reference for updating and improving the Chinese Clinical Practice Guidelines for BPH.